What Do We Know About Component Separation Techniques for Abdominal Wall Hernia Repair?

Area of Science:

• Abdominal Wall Reconstruction
• Surgical Techniques
• Hernia Repair

Background:

• Component separation technique (CST) is used for large, complex hernias.
• Technical modifications and patient heterogeneity complicate comparisons of CST outcomes.
• Standardized guidelines are needed for optimal CST application.

Purpose of the Study:

• To review and compare various component separation techniques (CSTs).
• To provide evidence-based recommendations for CST in abdominal wall reconstruction.
• To identify optimal techniques based on recurrence rates and surgical site occurrences.

Main Methods:

• Literature search of Medline and PubMed up to August 2017.
• Focus on comparative studies and systematic reviews of CSTs.
• Analysis of outcomes including recurrence rates and surgical site occurrences.

Main Results:

• CST without mesh is associated with high recurrence rates and should be avoided.
• Open anterior CST has high surgical site occurrence rates; endoscopic or perforator sparing anterior CST is preferred.
• Posterior CST, including with transversus abdominis release (TAR), shows better results than open anterior CST.
• No significant differences between endoscopic anterior, perforator sparing anterior CST, and posterior CST with TAR.
• Robot-assisted posterior CST with TAR is a promising new alternative.
• Biologic meshes are not systematically recommended for CST.

Conclusions:

• Component separation technique (CST) should always incorporate mesh.
• Endoscopic or perforator sparing anterior/posterior CST are recommended.
• Posterior CST with transversus abdominis release (TAR) offers favorable outcomes.
• Robot-assisted posterior CST with TAR represents a significant advancement.